Achieving ≥70% of energy requirements during early enteral nutrition and short-term inflammatory-metabolic profiles in critically ill patients with sepsis: a prospective cohort study.

BACKGROUND: Sepsis is characterized by dysregulated inflammation, profound metabolic stress, and a high risk of protein-energy malnutrition in critically ill patients. This study examined the association between achieving ≥70% of estimated energy requirements during early enteral nutrition and short-term inflammatory-metabolic profiles in patients with sepsis. METHODS: This prospective observational cohort study was conducted between November 2024 and May 2025 in the intensive care unit of a state hospital in Turkey. A total of 201 patients with sepsis receiving enteral nutrition were classified according to whether they achieved <70% or ≥70% of estimated energy requirements during the first 7 days. Biochemical and inflammatory parameters were assessed at baseline and on Day 7, and prognostic nutritional indices, including the Prognostic-Nutritional-Index (PNI) and C-reactive-protein-albumin-lymphocyte (CALLY) index, were calculated. Between-group changes and adjusted day 7 outcomes were evaluated using appropriate comparative tests and ANCOVA models adjusted for baseline values, age, sex, BMI, and NRS-2002. RESULTS: The ≥70% energy adequacy group showed significant within-group reductions in CRP, urea, and creatinine by Day 7 (all p < 0.001). Between-group comparisons of days 7-0 changes showed significant differences for Δurea (p < 0.001), Δlymphocyte (p < 0.001), Δmonocyte (p < 0.001), and ΔPNI (p = 0.007), whereas ΔCRP (p = 0.083) and Δcreatinine (p = 0.156) did not differ significantly. In adjusted ANCOVA models, achieving ≥70% energy adequacy was associated with approximately 30% lower day 7 CRP values [exp(β) = 0.70, 95% CI:0.53-0.92, p = 0.011] and 18% lower day 7 urea values [exp(β) = 0.82, 95% CI:0.71-0.95, p = 0.007]. Albumin showed a borderline positive association (B = 1.14, p = 0.050), whereas creatinine, NLR, leukocyte count, PNI, and CALLY were not significantly associated with energy adequacy. CONCLUSION: The between-group difference in the prespecified change in CRP was not statistically significant. However, secondary adjusted analyses showed lower Day 7 CRP and urea values in patients achieving ≥70% energy adequacy. These findings should be considered exploratory and interpreted cautiously because of the observational design.